Coprolalia
Coprolalia is involuntary swearing or the involuntary utterance of obscene words or socially inappropriate and derogatory remarks. Coprolalia comes from the Greek κόπρος meaning "feces" and λαλία meaning "babbling, meaningless talk", from lalein, "to talk".Coprolalia. Dictionary.com, Accessed 30 October 2006. The term is often used as a clinomorphism, with 'compulsive profanity' inaccurately referred to as being Tourette syndrome. Related terms are copropraxia, performing obscene or forbidden gestures,Schapiro NA. "Dude, you don't have Tourette's": Tourette's syndrome, beyond the tics. Pediatr Nurs. 2002 May-Jun;28(3):243-6, 249-53. PMID 12087644 and coprographia, making obscene writings or drawings. While this source defines coprographia, it makes misrepresentations about copro phenomena in relation to Tourette's: they are not common, and not required for diagnosis. Characteristics Coprolalia encompasses words and phrases that are culturally taboo or generally unsuitable for acceptable social use, when used out of context. The term is not used to describe contextual swearing. It is usually expressed out of social or emotional context, and may be spoken in a louder tone or different cadence or pitch than normal conversation. It can be a single word, or complex phrases. A person with coprolalia may repeat the word mentally rather than saying it out loud; these subvocalizations can be very distressing.Cohen, J.E. and Levi-Pearl, S. Understanding Coprolalia - A misunderstood symptom. Available from the Tourette Syndrome Association, Accessed 30 October 2006. Coprolalia is an occasional but rare characteristic of Tourette syndrome, although it is not required for a diagnosis of Tourette's. In Tourette syndrome, compulsive swearing can be uncontrollable and undesired by the person uttering the phrases. Involuntary outbursts, such as racial or ethnic slurs in the company of those most offended by such remarks, can be particularly embarrassing. The phrases uttered by a person with coprolalia do not necessarily reflect the thoughts or opinions of the person. Coprolalia is also a rare symptom of other psychiatric disorders,Singer C. Tourette syndrome. Coprolalia and other coprophenomena. Neurol Clin. 1997 May;15(2):299-308. PMID 9115463 such as Lesch-Nyhan syndrome.Jinnah, HA. Lesch-Nyhan Syndrome. eMedicine.com (August 29, 2006). Accessed 28 October 2006. Prevalence According to the Tourette Syndrome Association, fewer than 15% of Tourette syndrome patients exhibit coprolalia, but it tends to attract more attention than any other symptom.Tourette Syndrome Association. Tourette Syndrome FAQ. Accessed 6 October 2006. There is a paucity of epidemiological studies of Tourette syndrome; ascertainment bias affects clinical studies. Studies on people with Tourette's often "came from tertiary referral samples, the sickest of the sick".Swerdlow, NR. Tourette Syndrome: Current Controversies and the Battlefield Landscape. Curr Neurol Neurosci Rep. 2005, 5:329–31. PMID 16131414 Further, the criteria for a diagnosis of Tourette's were changed in 2000, when the impairment criteria was removed from the DSM-IV-TR for all tic disorders,What is DSM-IV-TR? Accessed 29 September 2006. resulting in increased diagnoses of milder cases. Further, many clinical studies suffer from small sample size. These factors combine to render older estimates of coprolalia—biased towards clinical populations of the more severe cases—outdated. An international, multi-site database of 3,500 individuals with Tourette syndrome drawn from clinical samples found 14% of patients with Tourette's accompanied by comorbid conditions had coprolalia, while only 6% of those with uncomplicated ("pure") Tourette's had coprolalia. The same study found that the chance of having coprolalia increased linearly with the number of comorbid conditions: patients with four or five other conditions—in addition to tics—were four to six times more likely to have coprolalia than persons with only Tourette's.Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P. An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries. Dev Med Child Neurol. 2000 Jul;42(7):436-47. PMID 10972415 One study of a general pediatric practice found an 8% rate of coprolalia in children with Tourette syndrome, while another study found 60% in a tertiary referral center (where typically more severe cases are referred).Singer C. Tourette syndrome. Coprolalia and other coprophenomena. Neurol Clin. 1997 May;15(2):299-308. PMID 9115463 A more recent Brazilian study of 44 patients with Tourette syndrome found a 14% rate of coprolalia;Teive HA, Germiniani FM, Della Coletta MV, Werneck LC. Tics and Tourette syndrome: clinical evaluation of 44 cases. Arq Neuropsiquiatr. 2001 Sep;59(3-B):725-8. PMID 11593273 a Costa Rican study of 85 subjects found 20% had coprolalia;Mathews CA, Herrera Amighetti LD, Lowe TL, van de Wetering BJ, Freimer NB, Reus VI. Cultural influences on diagnosis and perception of Tourette syndrome in Costa Rica. J Am Acad Child Adolesc Psychiatry. 2001 Apr;40(4):456-63. PMID 11314572 a Chilean study of 70 patients found an 8.5% rate of coprolalia;Miranda M, Menendez P, David P, Troncoso M, Hernandez M, Chana P. disease (Gilles de la Tourette syndrome): clinical characteristics of 70 patients Rev Med Chil. 1999 Dec;127(12):1480-6. Spanish. PMID 10835756 older studies in Japan reported a 4% incidence of coprolalia;Kano Y, Ohta M, Nagai Y. Tourette syndrome in Japan: a nationwide questionnaire survey of psychiatrists and pediatricians. Psychiatry Clin Neurosci. 1998 Aug;52(4):407-11. PMID 9766689 and a still older clinical study in Brasil found 28% of 32 patients had coprolalia.Cardoso F, Veado CC, de Oliveira JT. A Brazilian cohort of patients with Tourette's syndrome. J Neurol Neurosurg Psychiatry. 1996 Feb;60(2):209-12. PMID 8708658 Considering the methodological issues affecting all of these reports, the consensus of the Tourette Syndrome Association is that the actual number is below 15 percent. Treatment Some patients have been treated by injecting botulinum toxin near the vocal cords. This does not prevent the vocalizations, but the partial paralysis that results helps to control the volume of any outbursts.Scott BL, Jankovic J, Donovan DT. Botulinum toxin injection into vocal cord in the treatment of malignant coprolalia associated with Tourette's syndrome. Mov Disord. 1996 Jul;11(4):431-3. PMID 8813224Jankovic J. Botulinum toxin in the treatment of dystonic tics. Mov Disord. 1994 May;9(3):347-9. PMID 8041378Kwak CH, Hanna PA, Jankovic J. Botulinum toxin in the treatment of tics. Arch Neurol. 2000 Aug;57(8):1190-3. PMID 10927800 Perception The entertainment industry often depicts those with Tourette syndrome as being social misfits whose only tic is coprolalia, which has furthered stigmatization and the public's misunderstanding of those with Tourette's. The coprolalic symptoms of Tourette's are also fodder for radio and television talk shows.Tourette Syndrome Association. Oprah and Dr. Laura - Conflicting Messages on Tourette Syndrome. Oprah Educates; Dr. Laura Fosters Myth of TS as "Cursing Disorder". (May 31, 2001). Accessed 6 October 2001. * Tourette Syndrome Association. Letter of response to Dr. Phil. Accessed 8 May 2006. * Tourette Syndrome Association. Letter of response to Garrison Keillor radio show. Accessed 8 May 2006. * Born, Matt. Tourette's man 'exploited by Big Brother' Accessed 22 May 2006. See also Notes Category:Neurological disorders Category:Symptoms Category:Tourette syndrome